Ovarian factors--- Infertility Causes-- Literature Review

2-2-3. Ovarian factors

Ovarian disorders are found in approximately 15% of all infertile couples and more than 40 % of unproductive female. (Saravelos, Cocksedge and Li 2008.). An obvious symptom of this disorder will be the disturbance of the menstrual cycle. However, it may be more subtle. The cause should be sought out and diagnosed critically because there is a specific treatment for the different types of disorders. The most common causes of ovarian disorders are the poly cystic ovarian syndrome (PCOS), obesity, weight loss, prolactinemia, thyroid dysfunction, and difficult doing exercises, (ASRM 2012)               








 

    The conception cycle is defined by preovulatory follicle measured 18 mm or more in size , many irregular cycles are caused by insufficient leuteal levels which may be a result of follicle rupture failure, empty follicle, and follicular retention (Healy et al 1994). It is possible for the normal female with normal menstrual cycle to have PCO and consequently low rate of fertilization and decreased opportunity for getting pregnant. Catteau-Jonard et al (2012), they found that, the PCO detected in 21-63% of the women were actually normal. Women with normal ovulation are generally connected to the normal monthly cycle, and ovulation disorder provides a history of oligomenorrhea or amenorrhea. This will be one of the causes of infertility due to ovulatory dysfunction; this disorder may be related either to the hypothalamicpituitary or due to the disorder of the ovary itself.  Hypothalamic-pituitary dysfunction may cause no or low levels of several hormones such as GnRH, FSH, and LH, resulting in an onset of ovarian disorders and anovulation. On the other hand, conditions such as ovarian tumor, ovarian failure and Turner syndrome may prevent the pregnancy by changing ovarian responses to the hormonal signalling leading to the infrequent ovulation (Harris et al 2013). Broekmans (2009) identified that lower level of ovarian reserve, infertility and early age of menopause may occur as a result of loss of oocytes before maturity.  The diminishing of oocytes quality related to the elevation of meiotic nondisjunction is associated with women age, this diminution of follicles quality decreases women opportunity to get pregnant. Ovarian reserve refers to the follicle and these follicles remain in the ovary at any specific time, including a number and quality of the follicle. This should be considered to provide evidence about the women ability to conceive. The ovarian reserve decreases gradually with age and when the age of menopause is achieved only very few follicles remain (Harris et al 2013). This decline of the follicle refers to both quality and quantity of the available follicle, therefore ovarian aging should always be considered as a differential diagnosis for ovarian disorders in the infertile women. Advanced age and history of previous ovarian surgery also present as the risk of ovarian dysfunction or diminishing of the ovarian reserve (Quaas and Dokras 2008). Before more than 60 years, PCOS was discovered as a common entity, the researcher identified that PCOS is a genetic disease (Legro andStrauss 2002). It is thought that the PCOS causes infertility as a result of elevated luteinizing hormone and androgen levels, which leads to the interruption of folliculogenesis and anovulation. It is believed that the pathophysiology of PCOS caused by several factors include,, hyperandrogenemia,  hyperinsulinemia, obesity, and elevated steady-state LH levels. However, the exact process behind this syndrome is still unknown and requires being investigated (Harris et al 2013).

2-2-4.Other factors

There are several factors that should be considered while performing the assessment of infertility, which could be identified as a cause of unexplained infertility. The first factor is the women age. Age is recognised as one of the important causes of female infertility, infertility increased gradually with age for both male and female, but it is more pronounced in female of age more than 40, when the chance of pregnancy declined to only about 5% per month with a spontaneous miscarriage rate of 34%to 52% (Denson 2006). The second risk factor was the implantation failure. The traditional knowledge of this concept as a cause of infertility is that the insufficient secretion of the progesterone may cause non -respective endometrium for the nidation of the bastocyst resulting in failure of pregnancy (Healy et al 1994). Third was the recurrent miscarriage, one third of women with recurrent abortion may have found to suffer from infertility, however, there is a little doubt regarding the connection between the repeated pregnancy wastage and infertility since two third are able to achieve pregnancy. The forth risk factors was the lifestyle factors which include nutrition, sports, clothing, alcohol drinking, tobacco and drugs. Fifth risk factors were psychological and occupational factors. A link is thought between the stress, anxiety and depression with infertility. However, the exact role of these conditions is still uncertain. The occupation also has a potential effect on the couple infertility. Occupation associated with high exposure of textile dyes, lead, and cadmium are the most important risk factors. These factors mostly find in women, who have unexplained infertility. Sixth risk factor was the male infertility, which may be as a result of obstructions of the duct or abnormalities of sperm production or the physiology of the sperm (Denson 2006). This study will not cover all these factors but will mainly concentrate only on the diagnosis and management of the female pelvic factors including uterus, tubal and peritoneal, and ovulatory factors, and understanding of these factors and causes of infertility along with identifying of the initial fertility assessment. These will possibly be used as a guide to formulate the diagnostic plan.

   

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